Early Prognostic Factors for Remission Achievement at Etanercept Therapy in Patients with Juvenile Idiopatic Arthritis Without Systematic Manifestations: Prospective Cohort Study

Abstract

Background. Prognosis of therapy results of patients with the juvenile idiopatic arthritis (JIA) without systematic manifestations is the precondition of their treatment efficiency enhancement.Objective. Our aim was to establish early predictors for remission achievement in patients with JIA without systematic manifestations who received Etanercept therapy.Methods. In prospective cohort study the therapy results of patients with JIA without systematic manifestations hospitalized from December, 2009 to August, 2014 and administrated with Etanercept are analysed. The association of initial demographic indicators as well as initial and registered after a month of treatment clinical and laboratory indicators with remission achievement after a year of treatment according to the Wallace criteria is estimated.Results. The research included 197 patients with JIA without systematic manifestations who received Etanercept in 0.4 mg/kg dose twice a week subcutaneously (the maximum single dose — 25 mg). In addition to Etanercept 136 (69%) patients received Methotrexat, 121 (61%) — non-steroidal anti-inflammatory drugs, 10 (5%) — glucocorticosteroids, 6 (3%) — Sulfasalazine. After a year of treatment remission was recorded in 77 out of 197 (39.1%) patients. According to multivariate analysis the remission predictors are the following: tender joint count 4 (odds ratio (OR) 4.38; 95% confidential interval (CI) 2.33–8.55), duration of illness before Etanercept therapy 2 years (OR 1.28; 95% CI 1.02–2.15), disease activity decline according to JADAS71 index 10 points in a month of the therapy including Etanercept (OR 2.59; 95% CI 1.38–5.03). Model sensitivity was 32% (all three criteria in 25/77 patients with remission), specificity — 94% (lack of even one criteria in 113/120 patients who did not achieve remission).Conclusion. The predictors of remission in patients with JIA without systematic manifestations in 1 year of Etanercept therapy are smaller tender joint count prior to therapy, smaller duration of illness as well as significant disease activity decline in a month of the therapy.